Obesity: physiologic changes and challenges during laparoscopy - 25/08/11

Doi : 10.1016/j.ajog.2004.05.077

Georgine Lamvu, MD, MPH ^a,^⁎ , Denniz Zolnoun, MD, MPH ^a, John Boggess, MD ^b, John F. Steege, MD ^b
^a Department of Obstetrics and Gynecology, Division of Advanced Laparoscopy and Gynecologic Surgery and Department of Obstetrics and Gynecology,
^b Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC

Reprint requests: Georgine Lamvu, MD, MPH, CB 7570, Department of Obstetrics and Gynecology, Division of Advanced Laparoscopy and Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599.

Résumé

Objective

The purpose of this report was to describe the evidence for the benefits of laparoscopic surgery in obese patients, to review the physiologic abnormalities that are associated with obesity, and to explore surgical techniques that will enable surgeons to perform laparoscopy successfully in obese patients.

Study design

This article is a review of the available literature on obesity, the physiologic changes that occur in obese patients, and the impact of these changes on laparoscopy outcomes.

Results

Obesity is associated with sudden death and a wide range of morbid conditions such as hypertension, atherosclerosis, angina, chronic obstructive disease, and diabetes mellitus. Recent studies have demonstrated that obese patients who undergo laparoscopy have shorter hospital stays, less postoperative pain, and fewer wound infections when compared with obese patients who undergo laparotomy. Laparoscopy patients also have fewer postoperative ileus and fevers.

Conclusion

With thorough preparation and careful preoperative evaluation, laparoscopy can be performed safely and is the preferred surgical method in obese patients.

Le texte complet de cet article est disponible en PDF.

Key words : Obesity, Laparoscopy

Plan

General physiologic changes in the obese patient

Surgical outcomes in obese patients who undergo laparoscopy

The impact of obesity on respiratory mechanics

Preparation, positioning and recommended surgical techniques for laparoscopy in the obese patient

Preoperative work-up

Panniculus and body type evaluation

Preparation of the operating room and staff

Positioning

Premedication

Access, pneumoperitoneum, and intraoperative technique

Postoperative care

Comment

Presented at the Sixty-Sixth Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, Boca Raton, Florida, January 18-21, 2004.